Ayurveda, which originated in ancient India more than 5,000 years ago, is probably the world's oldest system of natural medicine. When translated, its name means "science of life," and it stems from the ancient body of spiritual teachings known as the Vedas. Some medical historians believe that Ayurveda was also the original basis for Chinese medicine.

Ayurveda is an integrated system of specific theories and techniques that use diet, herbs, exercise, meditation, yoga, and massage or bodywork. The goal of Ayurveda is to achieve optimal health on all levels: physical, psychological, and spiritual.

In India, Ayurveda involves the eight main branches of medicine: pediatrics, gynecology, obstetrics, ophthalmology, geriatrics, otolaryngology (ear, nose, and throat), general medicine, and surgery. An estimated 80% of the Indian population uses Ayurveda, although it is often used in combination with conventional medicine. There are more than 250,000 Ayurvedic practitioners in India, and some hospitals are based solely on this approach to medicine.

Ayurveda made its way to the West mainly through Europe, where it still has a strong presence today. However, in modern times and particularly in western countries, the practice of Ayurveda is less focused on its spiritual roots than on its use as a form of complementary or alternative medicine.

Ayurveda is practiced in the West by healthcare professionals who are licensed in a variety of disciplines, such as MDs, osteopathic physicians (DOs), naturopaths, acupuncturists, nurses, massage therapists, and chiropractors. It is also practiced by lay people who are not licensed, but who function as health counselors, educators, or consultants. To practice this discipline, the standard length of training in India is five years, but there are no agreed upon standards in the West.

The West offers two major currents of training and practice. The first is offered by a diverse variety of teachers and practitioners, many of whom are either from India or were trained there. The second consists of devotees of Maharishi Mahesh Yogi, the Indian spiritual teacher who introduced transcendental meditation (TM) to the West. In 1980, this group coined the term "Maharishi Ayur-Ved," which incorporates TM as part of an Ayurvedic approach.

Ayurveda relies heavily on the individual's willingness to participate in lifestyle and behavior changes.

Similar to other traditions of nature-based medicine, Ayurveda teaches that vital energy, referred to as prana, is the basis of all life and healing.

As prana circulates throughout the human body, it is governed by the five elements: earth, air, fire, water, and ether. These terms represent subtle qualities of prana energy and how it expresses itself in the body. Health is a state of balance and harmony among the five elements, and illness occurs when there is imbalance or lack of harmony among them.

The five elements combine with one another into pairs called doshas. There are three doshas: vata (ether and air), pitta (fire and water), and kapha (earth and water).

Certain doshas predominate in each person from conception to determine their personal energetic constitution - called their prakriti - that stays with the person for life. Each person's prakriti has an identifiable pattern in which one or more doshas are dominant. Thus, there are seven prakritis possible: vata, pitta, or kapha; the combinations of vata-pitta, pitta-kapha, or vata-kapha; and the most complex, vata-pitta-kapha.

Illness or imbalance is referred to as the person's vikriti. The vikriti is described in terms of how the doshas are out of balance in comparison to the prakriti.

Ayurveda gives the highest priority to prevention, health promotion, and enhancement. When illness is present, however, it offers a complete system for treatment. The overall goal is always to foster balance and harmony among the doshas, and to purify and harmonize the entire mind/body system.

Disease entities or pathogens (germs, viruses) are not the main focus of treatment. Rather it is the person's level of balance and harmony between the doshas and elements and the consequent level of the body's resistance to illness that is of concern.

The health practices of Ayurveda are selected according to the person's prakriti and what energetic imbalances may be present. Foods, herbs, exercises, and other treatments are all chosen on the basis of their ability to regulate certain doshas.

Food and diet: The regulation of diet as a form of therapy is a central ideal; an individual's mental and spiritual development as well as temperament can be influenced by the quality and quantity of food consumed. An important principle in Ayurveda is that "there is nothing in the world that is not a medicine or food."

Foods and herbs are described in terms of their energetic qualities rather than the chemical properties of Western scientific understanding.

Food should be eaten according to one's prakriti (constitution). Certain foods should not be combined, and certain foods should be eaten at different times of day.

Spices are used to aid digestion or counteract the energetic qualities of different foods.

Chronobiology: Ayurveda holds that each 24-hour cycle is divided into four-hour segments that are governed by the doshas. From 10-2 (both a.m. and p.m.) is a pitta period, from 2-6 is a vata period, and from 6-10 is a kapha period. These time periods are believed to correspond with nature, and they dictate optimal times for certain activities or bodily functions such as exercise, work, rest, digestion, fasting, or healing. Practitioners guide patients to plan their activities to be in harmony with these natural principles of timing. For example, the mid-day pitta period is the time of strongest digestive function and should be the time of the largest meal; food should not be consumed during the night pitta period as this is a time of restoration and healing of vital organs.

Diagnosis: In an Ayurvedic theory, "diagnosis" means determining one's prakriti and what imbalances are present (vakriti), not by labeling specific diseases with Western terms. Ayurvedic theory calls for diagnosis using a variety of sources of information. A practitioner usually conducts an extensive individual interview for taking a health history, which may include written questionnaires. This information is followed by pulse diagnosis (palpating the wrist to determine subtle qualities of the pulse). Practitioners may also evaluate the appearance of the tongue, face, lips, nails, and eyes for diagnostic information. Some use laboratory tests of blood, urine, and stools to assist with diagnosis.

Most practitioners do not perform actual treatments or healing in the office, although some massage therapists will perform Ayurvedic massage.

Typically, the first consultation is the longest, lasting from 45-90 minutes. Follow-up consultations may be spaced several weeks or even months apart to monitor progress. These will usually be brief office visits involving diagnostic review and a fine-tuning of the treatment regimen.

Research support: Ayurveda is predominantly a "person-specific" approach. This means that two individuals with the same symptoms might be treated very differently in terms of herbal remedies, lifestyle changes, yoga postures, diet, or other factors. Such individualization makes it difficult to design Western-style clinical trials of Ayurveda treatment regimes. Nonetheless, several specific herbal formulations have been studied in Western-style clinical trials. Recent research in Ayurvedic genomics is examining if there is a link between a person's genetic composition and their response to Ayurvedic treatments.

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

GRADE *

There is some evidence that a traditional Ayurvedic treatment using specially prepared alkaline threads (ksharasutra or Ayurvedic setons) to achieve gradual cauterization may provide an effective alternative to surgery in patients being treated for anal fistulas. Further research is needed to confirm these results.

Arjuna (Terminalia arjuna) is a type of bark powder traditionally used as an anti-ischemic and cardioprotective agent in high blood pressure and ischemic heart diseases. It may be a safe and effective anti-angina agent comparable to isosorbine mononitrate (ISMN) and better tolerated. However, further research is needed before a recommendation can be made.

C

There is early evidence that daily supplementation with gum resin of Boswellia serrata, known in Ayurveda as Salai guggal, may improve shortness of breath, coarse rattling sounds in the chest (called rhonchi), and the number of asthma attacks.

Another herb, Devadaru (Cedrus deodara), may help prevent spasms in the airways, thereby reducing symptoms of bronchial asthma, particularly for patients with shorter histories of asthma and lower frequencies of attacks. Further research is needed in this area before a recommendation can be made.

C

Evidence suggests that carotid intima-media thickness (IMT), a measure of atherosclerosis, may be reduced with a comprehensive program including diet, exercise, stress reduction and a combination herbal formula (Maharishi Vedic Medicine), particularly in patients with a marked congenital heart disease (CHD) risk.

Studies also suggest that Maharishi Amrit Kalash (MAK) -4 and MAK-5, two modern formulations of traditional Ayurvedic herbal remedies, may also be useful in the prevention and treatment of artherosclerosis. However further research is needed to confirm these results.

C

Abana is a combination herbal and mineral formulation that has been traditionally used in Ayurveda for improved heart health. There is evidence from early studies that abana may improve heart function. Further research is needed before a recommendation can be made.

C

The herb Brahmi (Bacopa monnieri) is used in many Ayurvedic preparations for a variety of ailments. There is evidence from well-designed studies that it may improve memory and cognitive functioning in adults.

Another study suggests that the herbal preparation Maharishi Amrit Kalash (MAK) -4 may enhance attention capacity or alertness, and thus reverse some of the detrimental cognitive effects of aging. Further research is needed to confirm these results.

C

Preliminary evidence suggests that the gum resin of Boswellia serrata may improve or alleviate symptoms in patients with chronic colitis with minimal side effects. More studies are needed to confirm this finding.

C

Preliminary evidence suggests that sodium nimbidinate, made from the traditional Ayurvedic herb Nimba/Neem/Arishta (Azadirachta indica), may be an effective diuretic in patients with congestive heart failure. More studies are needed to confirm this effect.

C

Early evidence suggests that a liquid Ayurvedic herbal preparation called Misrakasneham, containing 21 different herbs, as well as castor oil, ghee, and milk, may benefit cancer-patients in the management of opioid-induced constipation. Further studies are needed to evaluate this treatment in palliative care.

C

Evidence indicates that Ayurveda's comprehensive purification and detoxification regime known as panchakarma in heart disease patients may lead to increased vasoactive intestinal peptide (a vasodilator), acute reduction in total cholesterol, reduction in lipid peroxide (a measure of free radical damage), and a significant reduction in anxiety.

A study of Arjuna (Terminalia arjuna), a type of bark powder that is traditionally used as an anti-ischemic and cardio protective agent in high blood pressure and ischemic heart diseases, found evidence that it may reduce cholesterol and lipid peroxide levels as well as have significant antioxidant action that is comparable to vitamin E in coronary heart disease patients. Further research is needed before a firm conclusion can be drawn.

C

Early evidence suggests that a traditional Ayurvedic formula containing extracts of four Indian herbs, Ashvatha, Kapikachu, Dhanvayasa, and Bhuriphali (the GS-02 formulation), may have benefits similar to conventional anti-depressant medication. Other research has reported no benefits. More studies are needed.

C

Several studies have been conducted with various Ayurvedic treatments, with mixed or modest results:

Drinking an aqueous suspension of the vegetable pulp from the herb Momordica charantia, a bitter vegetable popularly known as Karolla, may reduce serum glucose levels in people with moderate non-insulin dependent diabetes.

A traditional Ayurvedic formula called Pancreas Tonic, taken in a powder capsule form, may bring intermediate term glucose control in type II diabetic patients with elevated HbA(1c) levels.

In all the above remedies, better-designed trials are needed to determine the true effectiveness.

C

Early evidence suggests that the aqueous extract of O. sanctum leaves may benefit patients with viral encephalitis. However, human studies are needed to evaluate this approach.

C

Evidence from a well-designed study suggests that the Ayurvedic formula Pippali Rasayana, prepared from Palash (Butea monosperma [Lamk] Kuntze; Leguminaceae) and Pippali (Piper longum L.; Piperaceae), may be an effective treatment for intestinal giardiasis infection. Further research is needed before a recommendation can be made.

Another well-designed trial suggests that root powder from the herb Picrorhiza kurroamay may improve levels of bilirubin, SGOT (serum glutamic-oxaloacetic transaminase) and SGPT in viral hepatitis. Further research is needed before a recommendation can be made.

C

Abana is a combination herbal and mineral formulation that has been traditionally used in Ayurveda for heart health. Early studies show that abana may reduce blood pressure. Further research is needed to confirm these results.

C

There is preliminary evidence that the herb guggul (Commiphora) may reduce serum cholesterol and serum triglyceride levels, increase HDL and decrease LDL levels. More studies are needed to validate this use.

A compound Ayurvedic preparation with Aegle marmelos correa and Bacopa monnieri Linn is a traditional herbal preparation used for digestive disturbances and diarrhea. There is evidence from one study suggesting that this combination may have short-term benefits for patients with IBS in general, and in particular those with diarrhea. However, benefits may not be maintained in the long term. More studies are needed to evaluate this treatment.

C

Turmeric, an herb commonly used in Ayurvedic medicine, has been studied as a possible treatment for an inflammatory disorder of the mouth, called oral lichen planus. However, because the study was ended early, conclusions cannot be made. More research is needed.

C

There is evidence from one well-designed study that an Ayurvedic formula containing roots of Withania somnifera, the stem of Boswellia serrata, rhizomes of Curcuma longa, and a zinc complex (Articulin-F®) may significantly improve symptoms of osteoarthritis.

Another study suggests that taking guggul (Commiphora mukul) daily as a powder capsule supplement may reduce pain and improve functioning in OA. Further research is needed before a recommendation can be made.

C

There is evidence that the traditional herbal remedy Mucuna pruriens may improve symptoms in Parkinson's disease, and that it may offer advantages over conventional L-dopa preparations in the long-term management of the disorder.

One study has suggested that symptoms of Parkinson's disease may be reduced with use of an Ayurvedic formula called HP-200, which is derived from Mucuna pruriens.

More studies are needed to verify what can be expected from these treatments.

C

Evidence from one well-designed study suggests that the Ayurvedic herb Saptamrita Lauha may aid in the rapid absorption of hemorrhages and prevention of their recurrence in retinopathic eyes of diabetic and hypertensive patients. Further research is needed to confirm these results.

A resin that is extracted from Boswellia serrata (H15, indish incense) is thought to have anti-inflammatory effects. However, evidence from one study showed no benefit in patients with RA. More studies are needed to determine the efficacy of these treatments in RA.

C

There is preliminary evidence that the herb amalaki (Emblica officinalis / Phyllanthus emblica), a fruit used in a variety of Ayurvedic remedies including the popular general tonic Chyavanaprash, may reduce symptoms of gastritis and dyspepsia.

There is also evidence that the Ayurvedic herb Asparagus racemosus (Shatavari) may reduce gastric emptying time at a rate comparable to that of the drug metoclopramide, which is commonly used for dyspepsia.

Some of this research has been with healthy subjects however, and further clinical trials are needed using the above remedies to evaluate their efficacy.

C

Evidence is inconclusive on whether the traditional herb guggul (Medohar) may contribute to weight loss in obese patients. More studies are needed to examine this treatment.

C

One study compared the three Ayurvedic preparations bel (Aegle marmelos), thankuni (Hydrocotyle asiatica), and gandhavadulia (Paederia foetida) with ampicillin in shigellosis, and found them to have no effect.

D

* Key to grades

A: Strong scientific evidence for this useB: Good scientific evidence for this useC: Unclear scientific evidence for this useD: Fair scientific evidence for this use (it may not work)F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory
The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

Safety
Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Safety is the main concern when considering herbal preparations. Ayurvedic herbs are potent, and some contain compounds that may be toxic if taken in large amounts or over a long period of time. For this reason, the supervision of a trained practitioner is recommended.

It is important that the herbs come from a trustworthy source. Some Ayurvedic herbs from India have reportedly been contaminated with Western drugs, and there have also been reports of the accidental or intentional presence of toxic metals in imported herbs.

Examples of contraindications to the use of Ayurveda include traumatic injuries, acute pain, advanced disease stages, and those requiring surgery.

Amlaki (amla, Emblica officinalis) should be avoided at bedtime to prevent harmful effects on teeth.

Pippali (Piper longum) used in asthma should be avoided in patients with peptic ulcer disease and should be consumed with milk.

Guggul should be used cautiously in patients with peptic ulcer disease. Users should avoid sour food, alcohol, and heavy exercise.

Sweet flag (Vacha, Acorus calamus) is presently classified as an unsafe herb for internal usage by the U.S. Food and Drug Administration (FDA).

Terminalia hebula (harda) is a powerful purgative to stimulate gastrointestinal motility and should be avoided in pregnancy.

Mahayograj Guggul contains lead and is often prescribed for rheumatoid arthritis with the warning that it should not be taken for long periods of time because of the theoretical possibility of lead poisoning.

Ayurvedic preparations can often change the bioavailability of allopathic drugs so a medical professional should be consulted before combined use.

It is important not to self-diagnose. Instead, patients should work with qualified Ayurvedic practitioners who can help ensure that Ayurvedic treatments are safely used.

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.